Impact of COVID-19 on long term care: the case of residential facilities. SESPAS Report 2022

Las residencias de mayores han sido el foco de mayor impacto de la COVID-19 en materia de mortalidad y de situaciones extremas, junto con los centros sanitarios. El principal objetivo de este artículo es describir cómo afectó la llegada del SARS-CoV-2 a las residencias de mayores en Espa˜na durante los primeros meses pandémicos, y apuntar lecciones aprendidas. Pese a las medidas y normativas aprobadas en las primeras semanas de marzo de 2020, las residencias no estaban preparadas para la llegada de una epidemia como la vivida. El indicador más claro de ello es un fuerte impacto sobre la mortalidad en las residencias. El exceso de fallecimientos en las residencias se ha estimado en 26.448 personas entre marzo de 2020 y mayo de 2021 (un 10,6% del total de las personas dependientes atendidas en residencias, con un exceso de mortalidad del 43,5%), concentrándose las muertes en los primeros meses de la pandemia. Sin embargo, hay otros efectos que cabe rese˜ nar, como los que afectan a la salud mental y la calidad de vida de residentes, familiares y personal de las residencias. Asumiendo que posiblemente no hay dos pandemias iguales, es imprescindible extraer de la experiencia vivida ense˜nanzas que puedan resultar de utilidad para estar preparados ante situaciones futuras similares y reforzar un sistema de cuidados de larga duración que ya era frágil antes de la llegada del SARS-CoV-2.Facilities have been the focus of the greatest impact of COVID-19 in terms of mortality and extreme situations, along with health centers. The main objective of this article is to describe how the arrival of SARS-CoV-2 affected facilities, focusing on Spain during the first pandemic months, and to point out lessons learned. Despite the measures and regulations approved in the first weeks of March 2020, these centers were not prepared for the arrival of an epidemic such as the one experienced. The clearest indicator of this is a strong impact on mortality in residential facilities. The excess of deaths in residences has been estimated at 26,448 people between March 2020 and May 2021 (10.6% of the total number of dependents cared for in residences, with an excess mortality of 43.5%), with deaths concentrated in the first months of the pandemic. However, there are other effects to be considered such as those that affect the mental health and quality of life of residents, family members, and residential facilities staff. Assuming that no two pandemics are possibly alike, it is essential to draw lessons from lived experience that may be useful to prepare for similar future situations and strengthen a long-term care system that was already frail before the arrival of SARS-CoV-2

The Spanish long-term care system in transition: ten years since the 2006 Dependency Act

At the end of 2006, a new System for Promotion of Personal Autonomy and Assistance for Persons in a Situation of Dependency (SAAD) was established in Spain through the approval of the Act 39/2006 of 14th December (the Dependency Act, DA). The DA acknowledged the universal entitlement of Spanish citizens to social services. The recent economic crisis added degrees of uncertainty to several dimensions of the SAAD implementation process. Firstly, the political consensus on which its foundation rested upon has weakened. Secondly, implementation of the SAAD was hampered by several challenges that emerged in the context of the economic crisis. Thirdly, the so-called “dependency limbo” (i.e. the existence of a large number of people eligible for benefits but who do not receive them) has become a structural feature of the system. Finally, contrary to the spirit of the DA, monetary benefits have become the norm rather than a last resort. High heterogeneity across regions regarding the number of beneficiaries covered and services provided reveal the existence of regional inequity in access to long-term care services in the country. Broadly, the current evidence on the state of the SAAD suggests the need to improve the quality of governance, to enhance coordination between health and social systems, to increase the system's transparency, to foster citizens’ participation in decision-making and to implement a systematic monitoring of the system

The employment situation of people living with HIV: a closer look at the effects of the 2008 economic crisis

This study aims to assess the determinants of employment probabilities among people living with Human Immunodeficiency Virus (HIV) during a 15-year period (2001–2016) in Spain, focusing on the possible effects of occurrences such as the 2008 economic crisis. The probability of people living with HIV having a job was evaluated by applying several multivariate probit regression models. Differences between the employment status of people living with HIV and that of the general population were evaluated by applying genetic matching regression models. With respect to the former evaluation, for people living with HIV, the period before the crisis (2001–2007) was associated with a probability of being employed that was 2.43 percentage points (p.p.) higher than during the crisis, and the period after the crisis (2014–2016) with a probability that was 7.58 p.p. lower than during the crisis. Greater effects were also observed among males, the probability of being in employment before the economic crisis being higher (by 2.26 p.p.) and lower after the crisis (− 3.41 p.p.) than among women, and among those infected through drug use (6.18 p.p. and − 7.34 p.p. before and after the crisis, respectively), than among those infected through sex. When analysing the differences with respect to the general population, people living with HIV reported lower probabilities of being employed: by − 18 p.p. before the crisis, by − 15 p.p. during the crisis (years 2008–2013) and by − 10 p.p. after the crisis, implying a convergence in the prospects of employment with the passage of the years. Those differences were greater for people of basic educational level (− 23 to − 16 p.p.), a weaker immune system (− 34 p.p. to − 21 p.p.) and those infected through the use of drugs (− 31 p.p. to − 26 p.p.). Although the results suggest that the economic crisis had a greater effect on the employment prospects of people living with HIV, and that effect is still felt by that group, our findings also point towards a convergence of their employment prospects with those of the general population, over the 15-year period assessed. An analysis of the employment situation of people living with HIV might have helped when designing job-seeking methods and policies on the working environment, especially through the 15-year period considered, when the economic crisis had a greater effect on the job market

The Effects of Severe Acute Respiratory Syndrome Coronavirus 2 on the Reported Mental Health Symptoms of Nonprofessional Carers: An Analysis Across Europe

Objectives This study tries to analyze how the crisis generated by severe acute respiratory syndrome coronavirus 2 has affected the reported mental health symptoms of informal caregivers in different European countries. Methods The Survey of Health, Ageing and Retirement in Europe-COVID-19 was used, collecting information from the beginning of June 2020 to August 2020 about individuals’ state of health and the care they received. Several probit regression models were used to analyze the differences in the probability of (1) being sad or depressed, (2) being anxious or nervous, (3) having difficulty sleeping, and (4) feeling lonely, between individuals who provided informal care and individuals who did not. Several subanalyses by geographic area, mortality rates due to coronavirus disease 2019 (COVID-19), and long-term care expenditure were also performed. Results Since the outbreak of COVID-19, informal caregivers have had a higher probability of being sad or depressed of 8 percentage points (p.p.), a 7.1 p.p. higher probability of being anxious or nervous, and a 5.9 p.p. higher probability of having difficulty sleeping than non-caregivers. Informal caregivers in Southern Europe have had an 8 p.p. higher probability of being sad or depressed than non-caregivers. In Eastern Europe, this difference in probability reaches 9.7 p.p. Finally, in countries with higher mortality rates due to COVID-19, there have been greater differences in terms of being sad or depressed between caregivers and non-caregivers, regardless of expenditure on long-term care. Conclusions Since the outbreak of COVID-19, informal caregivers in Europe have had a higher probability of reporting mental health symptoms than non-caregivers

Pérdidas laborales ocasionadas por muertes prematuras en España : un análisis para el periodo 2005-2009

Fundamentos: El impacto económico que causan las enfermedades va mucho más allá del gasto sanitario, transmitiéndose a la sociedad a través de diferentes dimensiones. El principal objetivo de este estudio fue estimar la evolución de las pérdidas de productividad laboral causadas por muertes prematuras en España durante el periodo 2005-2009. Métodos: Se emplearon varias fuentes estadísticas (Registro de defunciones según la causa de muerte, Encuesta de Población Activa y Encuesta de Estructura Salarial) para desarrollar un modelo de simulación basado en el enfoque de capital humano que permitió estimar las pérdidas laborales ocasionadas por muertes prematuras para el periodo analizado. Adicionalmente, se llevaron a cabo dos escenarios alternativos en los que se analizó la influencia de la evolución epidemiológica en los resultados obtenidos. Resultados: El modelo de simulación mostró una caída de las pérdidas laborales asociadas a muertes prematuras que fue desde 8.935 millones de euros en 2005 a 8.073 millones de euros en 2009. El análisis de las causas reducidas de muerte señaló que nueve causas de enfermedad (accidentes de tráfico, tumor maligno de tráquea, suicidios, infarto agudo de miocardio, SIDA, cirrosis, tumor de mama, enfermedades cerebrovasculares y cáncer de colon) supusieron el 35,6% del total de Años Potenciales de Vida Laboral Perdidos y 36,6% del total de pérdida estimada. Las pérdidas estimadas representaron el 0,98%, 0,85% y 0,77% del Producto Interior Bruto de 2005, 2007 y 2009, respectivamente. Conclusiones: Las pérdidas laborales ocasionadas por muertes prematuras en España disminuyeron sustancialmente en el periodo analizado. Esta reducción se debió fundamentalmente a la favorable evolución epidemiológica de la mortalidad prematura.Background: The economic impact caused by diseases goes far beyond health care costs and, therefore it is transferred to the society through different dimensions. The aim of this study was to estimate the productivity losses due to premature deaths caused by diseases occurred in Spain during the period 2005-2009. Methods: We used data from several sources (Death Registry, Labour Force Survey and Wage Structure Survey) to develop a simulation model based on the human-capital approach that allowed us to estimate the labour productivity losses caused by premature deaths in the period analysed. Additionally, we also carried out two alternative scenarios in which we analysed how epidemiologic data influenced our results. Results: Our model showed the estimated loss of productivity due to premature death fell from 8,935 billion euros in 2005 to 8,073 billion euros in 2009. Nine diseases (traffic accidents, malignant tumour of the trachea, suicides, acute myocardial infarction, AIDS, cirrhosis, breast tumour, cerebrovascular disease and colon cancer) accounted for 35.6% of the total Years of Potential Productive Life Lost and 36.5% of the estimated productivity losses. The estimated losses represented 0.98%, 0.85% and 0.77% of Gross Domestic Product in 2005, 2007 and 2009, respectively. Conclusions: The labour productivity losses caused by premature deaths decreased substantially in the period analysed. This reduction was mainly due to the epidemiological evolution of premature mortality

Economic burden and health‑related quality of life in tenosynovial giant‑cell tumour patients in Europe: an observational disease registry

Background: Tenosynovial Giant-Cell Tumour (TGCT) is a benign clonal neoplastic proliferation arising from the syn‑ ovium, causing a variety of symptoms and often requiring repetitive surgery. This study aims to defne the economic burden—from a societal perspective—associated with TGCT patients and their health-related quality of life (HRQOL) in six European countries. Methods: This article analyses data from a multinational, multicentre, prospective observational registry, the TGCT Observational Platform Project (TOPP), involving hospitals and tertiary sarcoma centres from six European countries (Austria, France, Germany, Italy, the Netherlands, and Spain). It includes information on TGCT patients’ health-related quality of life and healthcare and non-healthcare resources used at baseline (the 12-month period prior to the patients entering the registry) and after 12 months of follow-up. Results: 146 TGCT patients enrolled for the study, of which 137 fulflled the inclusion criteria. Their mean age was 44.5 years, and 62% were female. The annual average total costs associated with TGCT were €4866 at baseline and €5160 at the 12-month follow-up visit. The annual average healthcare costs associated with TGCT were €4620 at baseline, of which 67% and 18% corresponded to surgery and medical visits, respectively. At the 12-month follow up, the mean healthcare costs amounted to €5094, with surgery representing 70% of total costs. Loss of productivity represented, on average, 5% of the total cost at baseline and 1.3% at follow-up. The most-afected HRQOL dimensions, measured with the EQ-5D-5L instrument, were pain or discomfort, mobility, and the performance of usual activities, both at baseline and at the follow-up visit. Regarding HRQOL, patients declared a mean index score of 0.75 at baseline and 0.76 at the 12-month follow-up. Conclusion: The results suggest that TGCT places a heavy burden on its suferers, which increases after one year of follow-up, mainly due to the healthcare resources required—in particular, surgical procedures. As a result, this condi‑ tion has a high economic impact on healthcare budgets, while the HRQOL of TGCT patients substantially deteriorates over time

Recommendations for Emerging Good Practice and Future Research in Relation to Family and Caregiver Health Spillovers in Health Economic Evaluations:A Report of the SHEER Task Force

BackgroundOmission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed.AimTo promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice.MethodsA modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds.ResultsThis report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed.ConclusionsConsideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation

The hidden social impact of informal care in elderly people

La tesis tratará de analizar el impacto social (no visible) que la sociedad en su conjunto tiene que afrontar debido a los cuidados prestados por el entorno más cercano de las personas dependientes (cuidados informales). En general, el análisis realizado señalará la gran importancia del papel que representa la familia en el cuidado prestado a la población dependiente de edad avanzada, y el incuestionable coste social (en términos de pérdidas en salud, calidad de vida y el bienestar social) que la sociedad tiene que hacer frente como consecuencia de los cuidados prestados. Concretamente, la tesis estará compuesta por tres capítulos donde se analizará, por un lado, la calidad de vida media de los pacientes atendiendo por tipo de cuidado que reciben (esto es, cuidado informal, formal, formal remunerado o ambos tipos de cuidados). Además, se estudiará el impacto que los cuidadores informales soportan (en el ámbito de salud, profesional y social) como consecuencia de los cuidados prestados, atendiendo por tipo de enfermedad crónica. Finalmente, se estimará el valor monetario de los servicios informales prestados a personas con discapacidad en España. En el Capítulo 1 se calculará la productividad media de la atención recibida, tanto formal, formal remunerado, informal como ambos tipos de cuidado, en términos de calidad relacionada con la salud de las personas de edad avanzada en Reino Unido. Se utilizarán dos conjuntos de datos longitudinales diferentes (el Estudio Longitudinal de Envejecimiento Inglés (ELSA) y la Encuesta de Salud de Inglaterra (HSE)). En estas bases de datos se analizan 20.774 personas durante el periodo comprendido entre 2002 y 2012. Se utilizarán varios modelos lineales longitudinales de regresión de efectos fijos para estimar la productividad media del cuidado informal, formal y formal remunerado, en términos de calidad de vida (Años de vida ajustados por calidad, AVAC) en ancianos. Los resultados esperados apuntan a que el recibir conjuntamente cuidado formal e informal tendrá un efecto positivo sobre la calidad de vida de los pacientes. En el segundo capítulo se utilizará la Encuesta sobre Discapacidades, Autonomía Personal y Situaciones de Dependencia (EDAD-08) realizada por el Instituto Nacional de Estadística español en el año 2008, donde se entrevistó a 96.000 hogares españoles y 22.795 personas con discapacidad. Con ello, se estimará tanto la carga de trabajo para los cuidadores informales de personas con enfermedad de Alzheimer (EA) y la Enfermedad Pulmonar Obstructiva Crónica (EPOC) como el impacto en la salud de los cuidadores, la vida social y profesional de los mismos. También se estimarán los principales factores que explican la variabilidad del tiempo invertido en la prestación de cuidados, teniendo en cuenta las dos enfermedades crónicas estudiadas. Los resultados esperados se encaminan hacia una relación positiva entre el grado de dependencia de la persona cuidada y la carga soportado por la persona cuidadora. Por último, en el capítulo 3 se obtendrá una aproximación del valor monetario de los cuidados no profesionales prestados a las personas con discapacidad que viven en España. Para este fin, se aplicarán los tres enfoques más empleados en la literatura: método de sustitución o reemplazo, método del coste de oportunidad y método de valoración contingente. La originalidad de este capítulo reside, por una parte, en realizar una aproximación al valor del cuidado informal desde una perspectiva nacional. Este tipo de trabajos es muy escaso es la literatura internacional debido a la dificultad de acceso a las bases de datos apropiadas para poder abordar una estimación de esta magnitud. En segundo lugar, lo común es encontrar trabajos que emplean uno o, a lo sumo, dos enfoques de valoración. La aplicación de estos tres métodos nos permitirá analizar las posibles diferencias en las estimaciones realizadas sobre el valor del cuidado informal desde diferentes enfoques planteados. Para ello, se utilizará la Encuesta sobre Discapacidades, Autonomía Personal y Situaciones de Dependencia (EDAD-08) realizada por el Instituto Nacional de Estadística español en 2008. Los resultados preliminares apuntan a una estimación del valor monetario que oscilará entre el 2% y el 5% del Producto Interior Bruto (PIB) de España (dependiendo del enfoque aplicado). En términos generales, para obtener un desempeño eficaz del sistema de atención a la dependencia es importante tener en cuenta no sólo si el sistema de atención a la dependencia es económicamente sostenible o no, sino también el impacto social que el cuidado podría producir tanto en las personas que reciben los cuidados como en los cuidadores. Esta tesis tratará de dar una aproximación de esos recursos calificados de invisibles pero que son totalmente relevantes e incluso, claves para conseguir un rendimiento adecuado y efectivo del sistema de atención a la dependencia

The Economic Value of Non-Professional Caregiving A Europe-Wide Analysis

Background This paper had two aims. Firstly, to provide a broader view of the profile of non-professional caregivers in Europe, and secondly, to estimate the economic value of the non-professional caregiving. Methods The European Quality of Life Survey 2016/2017, carried out by Eurofound, was used. The target population of the survey was adults who care for a relative or friend in a total of 33 European countries. The opportunity cost method was used to estimate the economic value of caregiving, in which two of the activities forgone were analysed: paid activities (restricted to caregivers who were employed), for which the average gross wage of each country was used; and unpaid activities, for which the minimum gross wage of each country was used. Results There were more than 76 million non-professional caregivers in Europe that provide care for a relative or friend. This figure represents 12.7% of the population in Europe. The estimated time devoted to non-professional care in Europe reached 72 301.5 million hours in 2016. Sharp differences were found among countries. The economic value of that time is estimated at 576 000 million of euros, which represented about 3.63% of Europe’s gross domestic product (GDP). Conclusion This study shows the very important number of resources dedicated to the non-professional care of dependent people and their economic valuation. These results may be helpful in prospective analyses estimating future needs on professional and non-professional and for designing of long-term care (LTC) policies in Europe

Differences in labour participation between people living with HIV and the general population: Results from Spain along the business cycle.

HIV/AIDS (Human immunodeficiency virus/Acquired immune deficiency syndrome) not only has a strong impact on the health of the worldwide population but also affects the labour status of HIV-positive people. The primary aim of this paper is to compare the labour participation of people living with HIV (PlwHIV) with the labour participation of the general population along the last business cycle in Spain.The data used are from the Hospital Survey on HIV-AIDS, with a total sample size of 4,651 PlwHIV and the Labour Force Survey from 2001 to 2010, with a total sample size of 660,674 individuals as general population. Propensity Score Matching method was used to analyse the differences between the labour participation of PlwHIV and the general population. Additionally, several specific models categorised into different subgroups (gender, education, source of infection and level of defences) were also performed.We identified a convergence in labour participation across the period in the two populations considered: PlwHIV was 23% less likely to have a job than the general population during 2001-2002 and 14% less likely during 2009-2010. This convergence is mainly explained by two facts: first, the positive evolution of people infected by sex; second, the change in the PlwHIV population composition with a decreasing weight of people infected by drug use throughout the decade. Thereby, at the end of period, there was no statistical difference in the employment rate between PlwHIV infected through sex and the general population but there was strongly difference in PlwHIV infected through drugs.Inmunological status, source of infection and level of education play a relevant role among the PlwHIV population when comparing their labour participation with the general population. In spite of this positive result, the likelihood of being employed in HIV-positive people continues to be different from that of non-carriers. Our study shows that institutional features of labour markets are relevant and should be considered in comparison between countries